Premium
Brain MR Spectroscopy Markers of Encephalopathy Due to Nonalcoholic Steatohepatitis
Author(s) -
Tran Thao T.,
Wei Ke,
Cole Soren,
Mena Edward,
Csete Marie,
King Kevin S.
Publication year - 2020
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon.12728
Subject(s) - medicine , hypoalbuminemia , cirrhosis , albumin , endocrinology , peripheral edema , hepatic encephalopathy , gastroenterology , adverse effect
ABSTRACT BACKGROUND AND PURPOSE In hepatic encephalopathy (HE), osmotic stressors promoting brain edema result in a compensatory drop in the astrocyte metabolite myo‐inositol (mI). Identifying differences between nonalcoholic steatohepatitis (NASH) with and without HE and healthy controls using proton magnetic resonance spectroscopy (MRS) and evaluating hypoalbuminemia and hyperammonemia as osmotic stressors that predict the reduction of mI allow further understanding of mechanisms that promote brain edema in HE. The aim of this study was to assess brain edema in HE using characteristic MRS markers and serum albumin. METHODS We evaluated between group differences among 19 NASH cirrhosis without HE (Crhs‐HE) (age = 63 ± 8.7), 9 NASH cirrhosis with HE (Crhs+HE) (age = 63 ± 9.2), and 16 controls (age = 57.8 ± 11.7) using 1 H MRS. Glutamine (Gln/tCr) and serum albumin were evaluated as predictors of myo‐inositol (mI/tCr) using linear regression. Statistical significance was set at P < .05 with adjustment for multiple comparisons. RESULTS Brain mI/tCr was decreased, and Gln/tCr increased in Crhs+HE compared to Crhs‐HE and controls in both brain regions ( P < .001 for all). Evaluated together as joint predictors, serum albumin but not Gln/tCr significantly predicted mI/tCr in GM ( P = .02 and P = .2, respectively) and PWM ( P = .01 and P = .1, respectively). CONCLUSION Low mI/tCr and increased Gln/tCr were characteristics of Crhs+HE. Low serum albumin was the strongest predictor of brain osmotic stress indicated by reduced mI/tCr, with no residual independent association seen for brain Gln/tCr concentration. This suggests that hypoalbuminemia in chronic liver disease may promote brain edema in HE.